How inflammation and thrombosis fuel disease and aging: Focus on NETs This R35 0IA application is an extension based on two recently funded NHLBI RO1 grants entitled ?NETS in thrombosis and inflammatory responses? and ?NETs and their modulating enzymes in age-related inflammatory diseases.? For many years, we have conducted a successful research program studying thrombosis and inflammation. Our current emphasis is on newly discovered neutrophil extracellular traps (NETs). Upon neutrophil activation, peptidylarginine deiminase 4 (PAD4) translocates to the nucleus to citrullinate histones. This decondenses chromatin, which is released as NETs. NETs trap microbes but we have shown a dark side of NETs, i.e., they promote thrombosis, inflammation and age-related heart and lung fibrosis. The central hypotheses of our program are: NETs are involved in the formation of a stable organized and vascularized thrombus and breaking up NETs is necessary for thrombolysis. Thrombosis promotes deposition of NETs in the adjacent vessel wall and also in distant organs leading to post-thrombotic syndrome and an increased systemic pro-coagulant and pro-inflammatory state. Aging promotes NET formation and NETs in turn escalate chronic inflammatory and thrombotic diseases. We believe that inhibition of the process of NET formation or destruction of NETs would be beneficial to the host. Finally, we hypothesize that genes regulating NETosis, such as peptidylarginine deiminase 4 (PAD4), impact aging. The work by the ?Wagner Lab? is considered innovative and solid; an objective measure is its high citation. The lab has always been funded by more than one NHLBI grant and for 15 years I was also the PI of a large PPG in Transfusion Biology. However, in the recent difficult funding period too much of my time was spent on securing support for my group. Obtaining prolonged funding would free my time for more mentoring, writing reviews, and collegiate activities. In addition, we now study chronic inflammatory diseases and their impact on aging. These experiments take time and the extended duration of support would assure that we could pursue this exiting research effectively.